The official finding that actor Heath Ledger died from an accidental overdose of a combination of six prescription drugs has brought attention to the danger of even prescribed medications.
"People have a false sense of security," says Michael Negrete, chief executive of the Pharmacy Foundation of California. "They think, 'I see it on TV all the time. All my friends are taking it.'
"People need to understand . . . these are dangerous medications."
With the wrong combination of pharmaceuticals, over-the-counter drugs, herbal preparations or alcohol, anyone can concoct a deadly mix. According to the Centers for Disease Control and Prevention, unintentional poisoning deaths - 95 percent of them drug overdoses - increased from 12,186 in 1999 to 20,950 in 2004.
"There isn't any absolutely safe medication," says Mark Boesen, spokesman for the American Pharmacists Association.
About 850,000 people annually misuse sedatives, including sleep aids, the CDC says. An estimated 14-million people misuse prescription drugs, including pain relievers, tranquilizers and stimulants.
Modern sleep drugs, such as Ambien, are less risky than previous versions of sleeping pills, in part because they are eliminated from the body quicker.
"The current generation of sleeping pills are safer," says Dr. Ian Cook, professor of psychiatry at University of California, Los Angeles. "Still, the danger goes up when people combine medications with other meds, or with alcohol."
Sometimes, users make mistakes during a sleepless night. "I think where people get in trouble is if they're taking a sleeping aid, and they're still tossing and turning," says Boesen, the pharmacists' spokesman.
Then they might take another pill, and another.
The current generation of prescription sleep drugs, says Dr. Greg Thompson, associate professor at the University of Southern California's School of Pharmacy, "interacts horribly with alcohol or Xanax (an anti-anxiety drug). The way accidental deaths occur is usually with a combination of pills and alcohol.
"If you drink a martini and then have another martini, you've had two," he explained. "But if you take a sleeping pill and then have a martini, you may have the equivalent of four martinis."
Over-the-counter drugs used as sleep aids, such as diphenhydramine (found in Sominex, Nytol and allergy medications, such as Benadryl), are less dangerous.
The biggest danger from those over-the-counter sleep aids is that they're often combined with acetaminophen (the active ingredient in Tylenol), and people may unwittingly take too much acetaminophen in a single day, which can lead to serious liver damage.
"People have the impression that once the FDA says (a medication) is okay, there must be very few things I need to be concerned about," said Boesen. "With drugs, the manufacturers don't put any cushion in the maximum recommended dose."
On the Web
Learn about drug interactions
For a guide to interactions, go towww.pharmacist.com and search for "interaction" or go to www.mypharmacist.com. The Web site www.fda.gov also has information on what consumers should know; click on "drugs."